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SEP-03-2003 WED 03;40 PM SEPnD-PORTLAND FAX NO, 5036097074 P. 02 <br /> —DATE IVE2 = EHD LOG NUMBER <br /> i _ I� \''/,I'- i )! SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 0 3 2003 304 E Weber Ave 3m Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> =NVIRCINMENT HEALTH I <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICAyTION n <br /> APPLICANT: 6mo '�CPI BUSINESSIAGENCY: SECo7Z (N1TrVta:�7�Y1GIA'. IhC• <br /> ADDRESS: JD I"/� 6 J7 ho S-frP /'oj / Q Qo Z <br /> PHONE: SOOJ �9 /— Z 030 RAN FACSIMILE'GO:J l b 9 Z� D 7 h <br /> TENTATIVE'APPOINTMENT DATE: 09-10'03 Time: 6M <br /> (Please allow 10 uslness days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE U 3.0 �UE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only co <br /> FILE ADDRESS UNIT <br /> s�� 25I lea rC - awKWa c a ro unit 1 <br /> :. sire• w;S lcf. u S A <br /> 00 � <br /> c' r ❑ Unit <br /> 4. SVae1 <br /> 5. Sve., Gd _ •_ - <br /> 6. si,�ei ci _ <br /> so-ux <br /> Urn <br /> s, sing <br /> C "� ❑ Unit 5 <br /> a. si2m c. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) W FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING)REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Yr HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> A TIERED PERMITTED FACILITY - ❑ MOTEUHOTEL ❑ PUMPER TRVCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA Q, L4NO USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY )E OTHER(PLEASE SPECIF10fIS�TS(A�,�e u,.d $iDru4C .) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209)464.0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the some condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> eHOu�zaoe <br /> venom <br />